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Chapter 25
Care of Patients
with Infection
Mrs. Kreisel MSN, RN
NU130 Adult Health 1
Summer 2011
Definitions
• Pathogen—any microorganism capable of
producing disease
• Communicable—infection transmitted from
person to person
• Pathogenicity—the ability to cause disease
• Virulence—the degree of communicability
Definitions (Cont’d)
• Normal flora—characteristic bacteria of a
body location; it often competes with other
microorganisms to prevent infections
• Colonization—the microorganism present
in tissue but not yet causing symptomatic
disease
• Surveillance—the tracking and reporting of
infections
Overview of Chain of Infection
• Reservoirs
• Pathogens:
• Toxins
• Exotoxins: A toxin produced by a
microorganism and excreted into its
surrounding tissue. (liquid medium,
unstable, light, heat and chemical
sensitivity)
• Endotoxins: bacterial toxin confined within
the body of the bacterium, freed only when
the bacterium is broken down.
• Host Defenses:
• Susceptibility
Immunity
• Resistance to infection is usually
associated with the presence of antibodies
or cells acting on specific microorganisms.
• Passive immunity is of short duration,
either naturally by placental transfer or
artificially by injection of antibodies.
• Active immunity lasts for years and occurs
naturally by infection or artificially by
stimulation (vaccine) of immune defenses
Antibodies
Antibodies Mechanism of Action
Portal of Entry Sites
•
•
•
•
•
Respiratory tract
GI tract
Genitourinary tract
Skin/mucous membranes
Bloodstream
Mode of Transmission
• Contact transmission by direct or indirect
contact
• Droplet transmission such as in influenza
• Airborne transmission such as in
tuberculosis
• Contaminated food or water
• Vector-borne transmission involving insect
or animal carriers, such as in Lyme
disease
• Portal of exit
Physiologic Defenses Against
Infection
•
•
•
•
Body tissues
Phagocytosis
Inflammation
Immune systems:
• Antibody-mediated immune system
• Cell-mediated immunity
Infection Control in Inpatient Health
Care Agencies
• Health care–associated Infection (HAI) is
acquired in the inpatient setting; not
present at admission.
• Endogenous infection is from a patient’s
flora.
• Exogenous infection is from outside the
patient, often from the hands of health
care workers.
Methods of Infection Control
• Practice hand hygiene and proper
handwashing.
• Personal protective equipment (PPE).
Nurse in Personal Protective
Equipment Caring for Patient in
Protective Isolation Room
EDUCATION TO
FAMILY ABOUT
PPE
Infection Control
• Adequate staffing
• Sterilization: free from all microorganisms
and spores
• Disinfection: Kills most microorganisms but
not spores
• Patient placement:
• Cohorting: pts with same illness placed
together
• Patient transportation: PPE if necessary
CDC and Prevention
Transmission–Based Guidelines
• Standard Precautions:
• Respiratory hygiene/cough etiquette
(RH/CE)
• Safe injection practices
Transmission-Based Precautions
• Airborne Precautions
• Droplet Precautions
• Contact Precautions
• KNOW PAGE 447
Methicillin-Resistant Staphylococcus
Aureus (MRSA)
•
•
•
•
Vancomycin
Linezolid
Community-associated MRSA
The best way to decrease the incidence of
this growing problem is health teaching
• CONTACT PRECAUTIONS/ISOLATION
Other Multi Drug Resistant
Organisms (MDROs)
•
•
•
•
Vancomycin-resistant Enterococcus (VRE)
Multidrug resistant tuberculosis
Gonorrhea
Vancomycin-intermediate Staphylococcus
aureus (VISA)
• Vancomycin-resistant S. aureus (VRSA)
Problems from Inadequate
Antimicrobial Therapy
• Noncompliance (deliberate) or
nonadherence (accidental)
• Legal sanctions that compel a patient to
complete treatment, such as in the
instance of tuberculosis (Directly Observed
Therapy DOT)
• Septicemia
• Septic shock
Collaborative Care
• History
• Physical assessment and clinical
manifestations
• Psychosocial assessment
• Laboratory assessment including:
• Culture and antibiotic sensitivity testing
• Complete blood count
• Erythrocyte sedimentation rate
• Serologic testing
• Imaging assessment
Community-Based Care
• Home care management
• Health teaching
• Health care resources
NCLEX TIME
Question 1
How many inpatients acquire health care–
associated infections yearly?
A.
B.
C.
D.
500,000
1,000,000
1,500,000
2,000,000
Question 2
Cleansing hands with alcohol-based hand
rubs is appropriate in which situation?
A. After administering medications to a
patient
B. After working with a patient who has
diarrhea due to Clostridium difficile
C. After using the bathroom
D. To cleanse visibly soiled or sticky hands
Question 3
A patient who has been admitted for newly
diagnosed tuberculosis will be placed on
which Transmission-Based Precaution?
A.
B.
C.
D.
Droplet Precautions
Airborne Precautions
Respiratory Precautions
Contact Precautions
Question 4
A patient may have infectious mononucleosis
and is awaiting laboratory confirmation of
this diagnosis. If the results are positive
for infectious mononucleosis, the nurse
would expect to see which laboratory
result?
A.
B.
C.
D.
Increased neutrophil levels
Decreased neutrophil levels
Decreased erythrocyte sedimentation rate
Increased lymphocyte levels
Question 5
Which person has the highest risk for having
Clostridium difficile–associated disease
(CDAD)?
A. A poultry farm worker
B. A person who has eaten a hamburger
that was cooked rare
C. A 2-year-old patient who has received IV
antibiotics for a week
D. An 82-year-old patient who has received
IV antibiotics for a week